37 Correlatie DNA copies/ml en zwangerschapsduurCorrelation between HCMV DNA load and gestational age at the time of AF sampling. The HCMV DNA load values were plotted against gestational age at the time of AF sampling, indicated in weeks of gestation (WG), for group A (A) and for group B (B) (see the Results section for definitions of the groups). The correlation was examined by the nonparametric Spearman test and was only found to be significant for group A, with a correlation coefficient of r = (P = 0.003).

49 Congenital Toxoplasmosis10-15%: symptoms at birth-> severe neurologic and ocular sequelae85-90% asymptomatic at birthBut : Majority of asymptomatic children will developsequelae later in life : 44% permanent loss ofvisual acuity after an 18 year follow-upSevere impairment of vision due to CT occurs in1-10 per individuals in western countries.

63 Inclusion criteria 1. Serological screening program for toxoplasmosisduring pregnancyseroconversions in IgG antibodies duringpregnancy3. All cases consecutive4. Follow-up of all live born children for at least1 year

69 CONCLUSIONS Antenatal antibiotic treatment has no impact on thefeto-maternal transmission rate (spiramycin study).2. Antenatal antibiotic treatment after a maternaltoxoplasma infection decreases significantly thesequelae in the children at birth and at the age of 1year. p = 0.026; OR = 0.30, 95 %, CI3. In the group of treated mothers, a beneficial effecton sequelae was observed when antibiotic treatmentwas started early after the maternal infection. p = 0.0214. The greatest impact of prenatal antibiotic treatmentwas seen on the development of severe sequelae.p = 0.007; OR = 0.14, 95 % CI

72 When to perform the prenatal diagnosis for cong. Toxoplasmosis?>18th week of pregnancy and >4 weeksafter the maternal infection based on thehypothesis of a time lag between maternaland fetal infectionno evidence for a time lag between the maternaland the fetal infection  amniocentesis from14-15 week onward

74 Possibilities of ultrasound in a non-selected population- Only percent of all congenital toxo-infections have symptoms at birth- Ultrasound abnormalities : hydrocephalus, intracranial calcifications, liver calcifications, ascites,hydropssensitivity of ultrasound less than 15 percent ; ultrasound is not a sensitive test for congenital toxoplasmosis

81 Results of prenatal diagnosis in congenitally infected and not infected fetusesParameter performed on amniotic fluid

82 Results of the prenatal diagnosis in congenitally infected and not infected fetusesParameter performed on fetal blood

83 CONCLUSIONS 1. T. gondii PCR on amniotic fluid as a singleparameter has the highest sensitivity (81 %) and a high specificity (96 %) .2. T. gondii PCR on AF + mouse inoculation of AFincreases the SE to 91 %.3. PD for congenital toxoplasmosis should alwaysinclude a PCR-assay on AF.4. Role for cordocentesis in the PD of congenitaltoxoplasmosis is limited.

84 GENERAL CONCLUSIONS1. In utero infection with T.g. may result in congenitaldefects (hydrocephalus, chorioretinitis, mentalretardation) or in long-term sequelae (impairment ofvision).2. Health education may decrease the incidence oftoxoplasmosis during pregnancy by 90%.3. Treatment during pregnancy results in a significantreduction in the incidence of sequelae of C.T.4. Prenatal diagnosis for cong.toxoplasmosis has a sensitivityand a specificity of >90%.